Introduction: Lateral retroperitoneal transpsoas interbody fusion (XLIF) is a recognized MIS technique which has been shown to minimize tissue destruction, blood loss and length of hospital stay. Its use for adult scoliosis correction has not been described. The purpose of this study is to quantify the specific impact of the XLIF alone on the radiographic correction in patients with adult scoliosis undergoing a staged anterior/posterior procedure.
Methods: Retrospective analyses of database of 201 adult scoliosis patients who underwent XLIF fusion from 2007 to 2010 were reviewed. 26 patients had full length standing scoliosis films pre- and post-operatively between stages. The investigation was focused on clinical and radiographic outcome.
Results: The mean age was 64.07 years (37-80 range). There was a 34.7° (74%) total Cobb angle correction. The mean preoperative curve magnitude was 47.7° (13-92°), which improved to 28° (5-58°) post- XLIF and to 13° (2-40°) after the posterior stage. The majority of correction was produced by the XLIF (43%) vs posterior stage (31%).
In the sagittal plane, pre-operative mean L1-5 lordosis was 32°(2-60°), 49° (36-73°) post XLIF, and 51° (39-65°) after the posterior stage. After the XLIF, 19 patients demonstrated an increase in coronal decompensation. 7 severely decompensated an additional 3.8cm to 6.4cm. The coronal balance consistently shifted to the side of the curve convexity after the XLIF. In the majority of patients (20/25) the posterior stage corrected the coronal balance. Mean back pain VAS improvement was 4.6 (2-7 range) and leg pain VAS improvement was 4.4 (1-10 range) points.
Conclusions: In adult scoliosis, XLIF provides significant correction in the coronal and sagittal plane but may lead to coronal decompensation between stages which needs to be corrected with the posterior procedure. We observed the origin of the coronal decompensation after XLIF is likely a result of the rigid fractional lumbosacral curve.
Patient Care: Characterize the proper utility of this surgical technique for patients with scoliosis
Learning Objectives: To investigate the impact of XLIF on adult deformity correction